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Property and Equipment (Tables)
 12 Months Ended
Dec. 31, 2017
Property, Plant and Equipment [Abstract]  
Property and Equipment
Property and equipment were comprised of the following:
 
December 31,
 
2017
 
2016
Land
$
33,814

 
$
26,339

Buildings
473,489

 
429,039

Leasehold improvements
2,816,675

 
2,495,070

Equipment and information systems, including internally developed software
2,352,246

 
2,182,912

New center and capital asset projects in progress
576,651

 
429,037

 
6,252,875

 
5,562,397

Less accumulated depreciation
(3,103,662
)
 
(2,698,276
)
 
$
3,149,213

 
$
2,864,121